Online CPR Certification Blog

Date: March 15th, 2014

The new law on health reform provides a guarantee that insurance companies must offer their beneficiaries coverage for emergency care at hospitals out of the network or in network and at the same rate. As par this law, health plans are not required to demand for prior authorization in case of emergency services. In addition, health plans are also mandated to follow the rule of ‘prudent layperson’.

This for example means that when a patient goes to the emergency room complaining of chest pain and is diagnosed with indigestion, such a claim must be covered simply because it made sense for the person to visit the hospital under such circumstances. These provisions will start for the plans covering emergency starting with the plans issued after September 23. Insurance plans have for many years been denying claims made on emergency room for many reasons but the new law aims at changing this for good.

A new federal website on insurance plans to be set up

In another story, regulators of insurance inundated with consumer confusion and questions regarding this new law on health are hoping that the pain will be alleviated by a consumer web site that will be rolled out soon. The federal Department of Health and Human Services will by July 1 set up a site with each state having its section. Small businesses and consumers can consult the site as they shop for insurance plans. This federal website will list each and every health plan as authorized by each of the states. In addition, there will be a list of network of providers of the plans, their service offerings, how to sign up and exactly who is eligible. This portal will include Medicare, Private plans, Medicaid, State Children’s Health Insurance Program as well as new high risk pools. This is considered to be the initial step of the eventual state based insurance plans exchanges.

The Washington Post in the meantime has reported that millions of people in District of Columbia have some pre- existing conditions, which are highly likely to exclude them from getting their own health insurance coverage. Most of the people in the area get their coverage through the employer sponsored plans and in case they were laid off, it would be very difficult for them to gain coverage. But under the health care legislation under Obama administration that stars in 2014, the insurers are going to be prohibited from charging higher premiums or turning people away because of someone’s health risk or medical history.

Insurers attempt to influence implementation of the new law

Finally, The Buffalo News says that insurers have been urging their colleagues to become more active in negotiation of finer details of the new rules as well as their implementation. Despite continuing reservations, the insurers have a very critical opportunity of influencing the ultimate application of the law. While some of the legislation aspects can clearly and easily be put into effect, others were written broadly and translation is required into specific regulations.